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Referral Form

*Please complete all mandatory fields to access our free services.

For our Counselling and Psychotherapy service please email: counselling.admin@rbmind.org

Can we leave voice messages?
Someone who can be contacted on your behalf in an emergency if you wish
Please tell us about our current situation and mental health concerns.
Please tell us about any other times you have experienced mental health issues, any self-harm, suicidal thoughts or attempts
Do you know which service(s) you are interested in? *

Click to see what services are available for Adults

For our Counselling and Psychotherapy service please email: counselling.admin@rbmind.org

Don’t know? click to see what services are available for Adults or click to see what services are available for Young People

Please select from the services listed below:

Adult Services

Children and Young People’s services
Do you need an interpreter?

Equalities monitoring questions are anonymised and analysed statistically to help us and our funders understand the extent to which our clients represent the local community we serve.

Ethnic Origin

How would you define your ethnicity?
Asian/Asian British
Mixed/multiple ethnic groups
African/African-Caribbean/Black British
White
Other Ethnic Background

Religion and Belief

Please tick as appropriate

Gender

How would you describe your gender identity?
Does your gender differ from how it was assigned at birth?

Sexual Orientation

How would you describe your sexual orientation?

Health Conditions and Disability

Do you identify as having any of the following? Please tick all that apply

Employment

How would you describe your current situation?

Financial Situation

Which of these statements best describes your current situation?

Any personal information you share with Richmond Borough Mind will be kept secure and used in line with the General Data Protection Regulation 2018 (GDPR). We may also make contact with other people supporting your mental health to discuss your referral. This information will only be used to assess your needs and the services that you may benefit from. Information about you will be kept confidential and will not be disclosed to third parties without your prior consent except where required by law, or where we are concerned about your safety or the safety of others. You can withdraw or change your agreement for Richmond Borough Mind to hold or process your personal information at any time.

  • I agree to monitoring information being held by Richmond Borough Mind and stored on their database
  • I understand that the following information may be shared with my GP, my care team or emergency services if there is a concern over my wellbeing or safety; or risk to myself or others

The information that we keep is used to ensure that we can:

  • contact you
  • make informed decisions about services and support you need
  • manage risks to your own wellbeing, and others’ wellbeing
  • review services to ensure they are effective
  • monitor numbers of people receiving a service
  • show what the funding was used for

Protection Regulation 2018 (GDPR) and our Privacy Policy.

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Donate e-news
Please enable JavaScript in your browser to complete this form.

Referral Form

*Please complete all mandatory fields to access our free services.

For our Counselling and Psychotherapy service please email: counselling.admin@rbmind.org

Can we leave voice messages?
Someone who can be contacted on your behalf in an emergency if you wish
Please tell us about our current situation and mental health concerns.
Please tell us about any other times you have experienced mental health issues, any self-harm, suicidal thoughts or attempts
Do you know which service(s) you are interested in? *

Click to see what services are available for Adults

For our Counselling and Psychotherapy service please email: counselling.admin@rbmind.org

Don’t know? click to see what services are available for Adults or click to see what services are available for Young People

Please select from the services listed below:

Adult Services

Children and Young People’s services
Do you need an interpreter?

Equalities monitoring questions are anonymised and analysed statistically to help us and our funders understand the extent to which our clients represent the local community we serve.

Ethnic Origin

How would you define your ethnicity?
Asian/Asian British
Mixed/multiple ethnic groups
African/African-Caribbean/Black British
White
Other Ethnic Background

Religion and Belief

Please tick as appropriate

Gender

How would you describe your gender identity?
Does your gender differ from how it was assigned at birth?

Sexual Orientation

How would you describe your sexual orientation?

Health Conditions and Disability

Do you identify as having any of the following? Please tick all that apply

Employment

How would you describe your current situation?

Financial Situation

Which of these statements best describes your current situation?

Any personal information you share with Richmond Borough Mind will be kept secure and used in line with the General Data Protection Regulation 2018 (GDPR). We may also make contact with other people supporting your mental health to discuss your referral. This information will only be used to assess your needs and the services that you may benefit from. Information about you will be kept confidential and will not be disclosed to third parties without your prior consent except where required by law, or where we are concerned about your safety or the safety of others. You can withdraw or change your agreement for Richmond Borough Mind to hold or process your personal information at any time.

  • I agree to monitoring information being held by Richmond Borough Mind and stored on their database
  • I understand that the following information may be shared with my GP, my care team or emergency services if there is a concern over my wellbeing or safety; or risk to myself or others

The information that we keep is used to ensure that we can:

  • contact you
  • make informed decisions about services and support you need
  • manage risks to your own wellbeing, and others’ wellbeing
  • review services to ensure they are effective
  • monitor numbers of people receiving a service
  • show what the funding was used for

Protection Regulation 2018 (GDPR) and our Privacy Policy.

Sign up to our e-newsletter
Loading
Crisis Support

Search our site

  • Home
  • About Us
    • Our Vision, Mission & Values
    • Our team
    • Our Newsletter
    • Our Impact
    • Our History
  • Support Us
    • Mental Elf Fun Run 2024 – Thank you
    • Donate
    • Fundraise
    • Corporate Partnerships
    • Leave a Legacy
    • In memory
  • Adults
    • Connect to Tech
      • Support in your home and Try before you buy
      • Get comfortable with technology
      • 65 and over
    • Psychotherapy & Counselling
    • NHS Richmond Talking Therapies
    • Journey Recovery Hub (Crisis Cafes)
      • LGBTQ+ Peer Support Group
    • Wellbeing Centre
      • Hearing Voices
      • Recovery from Trauma
      • Relaxation Group
      • Social Cafe
      • Identity
      • Outings
      • Wellbeing Self-Coaching
      • Sitting Yoga
      • Journalling
      • Art Group
    • Outreach
    • Peer Support
    • Peer Group Network Activities
      • Wellbeing Walks
      • All Ability Cycling
      • The Litter Challenge
      • Environmental Volunteering
      • Richmond Green Gym
      • Mindful Readers
      • Crafty Minds
      • Peer Lunch Club
      • Chatty Minds
      • Mind and Body Mindfulness
      • Young Adults Group
      • Become a Peer Group Volunteer
    • Mind n Mortlake
    • Positive Living Group
    • Befriending
  • Young People
    • Peer Support for Young Adults
  • Carers
    • Carers in Mind
      • Carers Events
      • 1-to-1 support
      • Take a break
      • Peer Support groups
      • Educational Workshops
      • Resources
    • Peer Support for Carers
  • Training
    • Mental Health First Aid (MHFA)
    • Mental Health and Wellbeing Training
  • Get Involved
    • Job Vacancies
    • Volunteering Vacancies
    • Workshops and Events
    • Communities
    • Service User Engagement
    • Equality, Diversity & Inclusion
  • Contact Us

Richmond Borough Mind

1st Floor Rear 
UK House
82 Heath Road
Twickenham
TW1 4BW

020 8948 7652
info@rbmind.org

Charity Number: 1146297
Registration Number: 7954134

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      • All Ability Cycling
      • Become a Peer Group Volunteer
      • Chatty Minds
      • Crafty Minds
      • Environmental Volunteering
      • Mind and Body Mindfulness
      • Mindful Readers
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  3. Donation Forms
Kathleen Farren

Kathleen Farren

I am Kathleen and I would like to raise funds for Mind to help support […]

Posted on: 8th May 2024

Dan Strachan

Dan Strachan

I’m taking on this challenge because I want to keep myself accountable in the gym and I know the awesome job Richmond Borough Mind do (because I’m one of the stars in the team).

Posted on: 1st May 2024

RMwalks

RMwalks

I love walking and want to raise awareness and funds for mental health services in […]

Posted on: 1st May 2024

Ruth Taylor

Ruth Taylor

I want to support with raising funds and awareness

Posted on: 1st May 2024

Pritty Rana

Pritty Rana

This May I’m walking the talk! Join me in the ‘100 Miles in May’ challenge, […]

Posted on: 30th April 2024

Gary Baker

Gary Baker

To help raise awareness of mental health within the Richmond borough and help raise money […]

Posted on: 30th April 2024

Suzanne Lynn

Suzanne Lynn

Small actions have a big impact. That’s why I’ve decided to take up the ‘100 […]

Posted on: 29th April 2024

Jo Neville

Jo Neville

I’m taking part in the 100 Miles in May challenge to raise awareness and vital […]

Posted on: 29th April 2024

Murray Cook

Murray Cook

Raising money for a great cause that helps those in need get the necessary support […]

Posted on: 29th April 2024

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In Memory Donation Form

Posted on: 7th September 2022

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Richmond Borough Mind

1st Floor Rear 
UK House
82 Heath Road
Twickenham
TW1 4BW

020 8948 7652
info@rbmind.org

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